نقش وحشت - ترس در آسم همزمان با اختلال پانیک

We examined mediational models of panic-fear, panic disorder (PD), and asthma outcomes among adult asthma patients. PD was assessed by the Anxiety Disorders Interview Schedule. Twenty-one asthma-PD patients and 27 asthma-only patients completed spirometry and questionnaires. Asthma-PD patients reported greater illness-specific and generalized panic-fear than asthma-only patients, despite no differences in asthma severity or physical symptoms during asthma attacks. Illness-specific panic-fear mediated the relationship between PD and poorer health-related quality of life, including emotional disturbance due to asthma. Illness-specific panic-fear was associated with more primary care office visits for asthma. Asthma-PD patients reported greater irritability during asthma attacks than asthma-only patients. Generalized panic-fear was directly associated with restriction of activities due to asthma and use of rescue medication for asthma. Neither measure of panic-fear was associated with asthma severity. Panic-fear experienced during asthma attacks may be an important area to target for improving health-related quality of life among asthma-PD patients.

Panic-fear has been established as a risk factor for greater asthma morbidity, independent of objective measures of pulmonary function (Dirks, Fross, & Evans, 1977; Dirks, Horton, Kinsman, Fross, & Jones, 1978; Dirks, Kinsman, et al., 1977; Dirks, Kinsman, Horton, Fross, & Jones, 1978; Dirks, Schraa, Brown, & Kinsman, 1980; Kleiger & Dirks, 1979). Most of this research was conducted in the 1970s on inpatients with asthma at National Jewish Medical and Research Center. Two types of panic-fear have been identified with each having a unique association with asthma morbidity. Illness-specific panic-fear refers to anxiety elicited in response to asthma symptoms. Generalized panic-fear is a stable, personality construct that reflects trait anxiety extending beyond asthma symptoms. Illness-specific panic-fear has been shown to be adaptive for asthma and the mechanism might involve vigilance to asthma symptoms (Kinsman, Dirks, Jones, & Dahlem, 1980). Patients with high illness-specific panic-fear were rehospitalized for asthma half as frequently within 6 months after discharge, compared with patients having low illness-specific panic-fear (Staudenmayer, Kinsman, Dirks, Spector, & Wangaard, 1979). Low illness-specific panic-fear was also a robust predictor of future asthma attacks and emergency health care use among patients who suffered a recent asthma attack (Greaves, Eiser, Seamark, & Halpin, 2002). Earlier research suggested that high illness-specific panic-fear was associated with overuse of PRN (i.e., as-needed) β2-agonist medications for asthma (Dahlem, Kinsman, & Horton, 1977). However, subsequent analyses of these data (Kinsman, Dirks, Jones, & Dahlem, 1980) and other research (Dirks, Fross, et al., 1977; Dirks, Jones, & Kinsman, 1977) have shown that high generalized panic-fear explains more variance than high illness-specific panic-fear in these maladaptive health outcomes. Kinsman, Dirks, and Jones (1982) concluded that high illness-specific panic-fear might mobilize the patient to carry out asthma self-management plans among patients with only moderate levels of generalized panic-fear. However, patients with high levels of both types of panic-fear are the most likely to panic during asthma attacks, use excessive asthma medications, and hyperventilate (Kinsman, Dirks, & Dahlem, 1980; Kinsman, Dirks, & Jones, 1980). Both high and low levels of generalized panic-fear have been linked to greater asthma morbidity. High levels of generalized panic-fear have been associated with overuse of PRN β2-agonist medications (Kinsman, Dirks, & Dahlem, 1980), stronger prescriptions of corticosteroids (Dirks, Horton, et al., 1978), longer hospitalizations (Dirks, Kinsman et al., 1977), and more frequent hospital readmissions for asthma (Dirks et al., 1980). The dependent and helpless nature of patients with high generalized panic-fear has been hypothesized as being particularly detrimental for asthma self-management (Kinsman, Dirks, Jones, & Dahlem, 1980). In contrast, the excessively independent nature characterized by low generalized panic-fear may result in failure to seek appropriate medical assistance for asthma. Low levels of generalized panic-fear have predicted high rates of rehospitalization (Dirks, Kinsman, et al., 1978) and underutilization of asthma medications (Kleiger & Dirks, 1979). All of these findings on panic-fear were independent of objective measures of asthma severity. More recently, attention in the asthma field has shifted toward panic disorder (PD). A growing body of clinical (Brown, Khan, & Mahadi, 2000; Carr, Lehrer, & Hochron, 1992; Carr, Lehrer, Rausch, & Hochron, 1994; Davis, Ross, & MacDonald, 2002; Lavoie et al., 2005 and Nascimento et al., 2002; Shavitt, Gentil, & Mandetta, 1992; Yellowlees, Haynes, Potts, & Ruffin, 1988) and community studies (Goodwin, Jacobi, & Thefeld, 2003; Hasler et al., 2005) have shown that there is significant comorbidity between asthma and PD. A 20-year longitudinal, community-based study showed that adults with asthma were View the MathML source412 times more likely to develop PD than adults without asthma (Hasler et al., 2005). Conversely, PD was also associated with subsequent asthma morbidity. Data on an overlapping sample of participants from the present study showed that asthma patients with PD (asthma-PD) had greater perceived impairment from asthma and health care utilization for asthma than patients without asthma (Feldman, Lehrer, Borson, Hallstrand, & Siddique, 2005). No differences were found on asthma severity. Models have been proposed addressing hypothesized mediators in this relationship between PD and adverse asthma outcomes (Feldman, Giardino, & Lehrer, 2000; Katon, Richardson, Lozano, & McCauley, 2004). However, there has been a gap in the literature addressing empirical support for these proposed mechanisms (Katon et al., 2004). The overarching goal of the present study was to bridge the gap in the asthma literature between panic-fear and PD by examining these anxiety constructs in the same sample of patients. The construct of health-related quality of life was never examined in the original panic-fear studies. Furthermore, illness-specific and generalized panic-fear have not been examined in asthma-PD patients. Although illness-specific panic-fear may be adaptive for some asthma outcome measures, high levels of anxiety focused on asthma may drive excessive worry between episodes and impair health-related quality of life among PD patients. We hypothesized that asthma-PD patients would report greater illness-specific and generalized panic-fear than asthma patients without PD (asthma-only). We also hypothesized that the previously reported link between PD and health-related quality of life (Feldman, Lehrer, et al., 2005) would be mediated by illness-specific panic-fear. Although this study includes a reanalysis of data previously reported (Feldman, Lehrer et al., 2005), we have not reported analyses on panic-fear data.